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Spreading the Facts on Viral Diseases

THE NEXT DDS

Dental professionals must be able to recognize clinical characteristics of viral diseases, understand the etiology of the disease, and discuss treatment and prognosis with their patients. A virus is defined as the causative agent of an infectious disease that is capable of multiplying in living cells.1 The herpes simplex virus is extremely common and can be divided into two types. Type 1 (HSV-1) is primarily responsible for infections of the oral cavity, while type 2 (HSV-2) is the source for genital infections. Overlap of the two virus types, however, does exist.2 Oral infections caused by the herpes simplex virus occur in initial (primary) and recurrent forms due to the virus’ ability to undergo remission and resurface at a later time.2

The initial or primary infection of herpes simplex is termed primary herpetic gingivostomatitis (PHGS) and commonly affects children from 6 months to 6 years of age.2-5 Patients that experience PHGS present with painful ulcers and vesicles on the gingiva, tongue, lips, and oral mucosa. Discomfort upon swallowing, swollen lymph nodes, and a fever are also symptoms associated with the infection; symptoms may last up to two weeks. The recommended treatment for primary herpetic gingivostomatitis includes rest, liquids, palliative mouthwash, acetaminophen, and/or ibuprofen for managing pain and fever as well as antiviral therapy with Acyclovir.2-4

Recurrent oral herpes simplex frequently presents as herpes labialis (cold sore/fever blister), a lesion that manifests itself on the vermillion border of the lips (Figure 1). Lesions on the lips appear as tiny vesicles that rupture, ulcerate, and become crusty. The lesion is most contagious in the vesicular stage, therefore, dental treatment should be postponed until crusting has occurred.2-5 Risk factors that contribute to recurrent outbreaks of herpes labialis include exposure to sun, anxiety, fatigue, hormones, trauma, stress, and other unknown causes. The use of sunscreen to prevent lesion formation, frequent hand washing to reduce the risk of spreading the virus, and topical remedies are recommendations that dental care providers can offer their patients. Recurrent herpes simplex can also occur intraorally and begin as small crops of vesicles that coalesce, rupture, and result in the formation of a single ulcer. Intraoral lesions are often found on keratinized mucosa, frequenting the hard palate and gingiva2-3,5 (Figure 2). Most cases of recurrent herpes simplex lesions are self-limiting and resolve in 7 to 10 days; however, some cases may be more persistent and are best treated with antiviral therapy.

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The coxsackievirus is responsible for two mild diseases with characteristics that resemble the herpes simplex virus--Herpangina and hand-foot-and-mouth disease. Herpangina presents intraorally as vesicles on the soft palate, with additional symptoms of fever, difficulty swallowing, and a sore throat.2-5 The signs and symptoms of hand-foot-and-mouth disease are painful vesicles and ulcers found in the mouth and on the tongue, accompanied by a sore throat, fever, and fatigue. Skin lesions also occur with this disease and are typically located on the palms of the hands and the soles of the feet.2-8 The differentiation between herpes simplex and the diseases caused by the coxsackievirus are the mild symptoms experienced by the patient and the location of the lesions found on the skin.2 These diseases generally resolve in 7 to 10 days. The use of acetaminophen and/or ibuprofen for managing pain and fever is recommended.2,6

Condyloma acuminatum is a papillary lesion caused by the human papilloma virus (HPV).2,7 This virus is a sexually transmitted disease and is most common in the anogenital region.2,7 In order for a patient to have an oral condyloma, one must have had oral-genital contact with the virus. Oral condylomas present as a pink broad-based mass with short, fingerlike papillary projections that resemble a raspberry.2,7 They may be found anywhere in the oral cavity, including the buccal and/or labial mucosa, palate, lingual frenum, and gingiva. The treatment for oral condylomas is surgical excision, as the virus is contagious and may spread to new areas in the oral cavity or be contracted by other individuals through direct contact. Additionally, oral healthcare providers should be aware that an oral condyloma found in a child may be indicative of sexual abuse.2,7 Currently, there is an interest in dental research to examine the potential link between HPV and oral cancers.8

Conclusion

Knowledge of viral diseases allows dental professionals the opportunity to educate patients on the duration, treatment, and prevention of such infections. It is important that oral healthcare providers make recommendations regarding viral diseases based on their patients’ signs and symptoms.

*Associate Professor and Junior Clinic Coordinator, Department of Dental Hygiene, University of New Haven, West Haven, Connecticut